VNHC to transfer home health care, hospice nursing patients

Masonicare to receive patients: Hospice to close due to dwindling reimbursements

Martin B. Cassidy, Staff Writer
| on October 10, 2011

STAMFORD -- Visiting Nurse and Hospice Care of Southwestern Connecticut plans to shut down and turn over its remaining patient load to Masonicare of Wallingford by late November due to the growing gap between reimbursements and treatment costs.

The Stamford-based agency has operated in Fairfield County since 1912. It has provided nursing and home health aide services, as well as physical, speech and occupational therapy and social work services to about 1,300 home health care and hospice patients in the last year, CEO and President Ingrid Jimenez said.

The agency employs more than 130 full-time and per-diem employees, she said.

The state Department of Health will oversee and monitor the transition and transfer of patients from VNHC's care to Masonicare Home Health & Hospice or other agencies to ensure quality of care is maintained, Jimenez said.

Mark Santagata, chairman of the Visiting Nurse and Hospice Care of Southwestern Connecticut's board of directors, said cuts to Medicare and insurance reimbursement rates and the loss of patients with greater ability to pay due to competition are factors in the decision to transfer operations to Masonicare.

With fewer patients who can pay a greater share of the costs of treatment, it is harder to garner enough private donations to cover deficits for patient care and remain solvent, Santagata said.

"A lot of people are attracted to the organization by the quality of service we provide and we try to be attractive at all levels by providing a high level of service and patient satisfaction," Santagata said. "...If you are a for-profit agency, you don't have a mission that requires you to take patients that maybe aren't able to pay, and we don't say we're not going to take those patients."

Santagata said most VNHC employees will be considered for employment by Masonicare; they are expected to be retained to handle future care needs in the community.

Major factors in the board's selection of Masonicare to take over is its larger size, making it more resilient to absorbing lower reimbursements and losses, and perhaps, more importantly, a similar commitment to treat patients, regardless of ability to pay, Santagata said.

Masonicare has an office in Norwalk, one of 10 branches in the state; it employs 2,500 people statewide, including 1,200 in its home care division.

"Our mission is to provide home medical care to those patients who require home medical care and we do it regardless of the level of reimbursement we are going to receive," Santagata said. "...Their primary objective is also to help the patient and less on the bottom line and corporate books at the end of the year."

A VNHC-Masonicare Advisory Board will be established in the coming weeks to continue fundraising efforts and allocate funds to health care needs in the Stamford community, Santagata said.

Letters notifying patients about the decision were sent out starting last week. The letters also provided additional information on making a choice between Masonicare or another health or hospice provider if necessary, Jimenez said.

The effect on the great majority of VNHC patients who receive home health care and hospice care is expected to be minimal, because most are discharged from the home health care program in fewer than 45 days, Jimenez said.

"Most of our patients are expected to recover and completed with treatment by then," Jimenez said.

Calls to the state Department of Health regarding the proposed closure were not returned Monday, a state holiday.

The agency employs about 69 full-time nurses, home health aides, therapists, administrators and other personnel on a full-time basis, and 61 other per diem employees in the same posts on an as needed basis, Jimenez said.

"We'll be interviewing the VNHC personnel over the next few weeks that want to transfer to Masonicare," Stephen McPherson, CEO and president of Masonicare said. "It will depend on how many patients transfer their care to Masonicare how many VNHC staff will remain."

Jimenez said VNHC nurses carry a caseload of 20 to 25 patients each week, and are responsible for balancing that group's treatment needs.

Another challenge to the service has been a new requirement Medicare placed on patients eligible for home health care coverage to visit a physician within 30 days after the start of home health care services to assess their status and continued eligibility.

Any lag in the timeliness with which physicians complete the necessary paperwork can affect how quickly the VNHC gets reimbursed for care patients continue to need, Jimenez said.

Several rounds of cuts to Medicare and Medicaid reimbursement rates have also caused financial difficulty for the operations, she said.

"The Face-to-Face document specifies why the patient needs care and is homebound and it has a list of questions the physician has to fill out and sign," Jimenez said. "Sometimes we can't bill without it."

Santagata said he believed the arrangement with Masonicare will provide a more competitive service while still giving local citizens a measure of control over the type of care given through the advisory board.

"The Stamford and Greenwich community will be served by a larger organization that is better insulated from the present financial uncertainty," Santagata said. "...At the same time the (advisory board) will continue its local fundraising efforts with the objective of identifying the healthcare needs of the community and focusing the new organization's vast resources to meet those needs."